In her foreword to Intimations, written on May 31, 2020, novelist Zadie Smith states that as a result of reading Stoic philosopher Marcus Aurelius’ Meditations, she discovered “two invaluable intimations. Talking to yourself can be useful. And writing means being overheard.”
That she needed to transform her private thoughts into public discourse about life in New York City during the first peak of the COVID-19 pandemic suggests fear that she too might sicken and die, and, like Marcus Aurelius, need to leave a legacy. Likewise, who among us didn’t fear for our lives then and feel unprepared for death!
I have lived with bipolar disorder for 50 years and have been a peer specialist since 2002 (first certified by New York State in 2015). For 25 years prior, I was an urban planner, with a public health degree, who learned how socio-economic challenges contribute to trauma.
As a peer support specialist for Vibrant Emotional Health’s behavioral health crisis line, NYC Well, from July 2020 to November 2022, I interacted with thousands of people during the pandemic who were overwhelmed because they had only themselves to talk to, and needed to be (over)heard and thus validated. Through “reflective listening” and “motivational interviewing,” I supported their self-care.
Smith quotes novelist Ottesa Moshfegh, who wrote, also during the pandemic, “Without love, life is just doing time.’” Many people who contacted us from New York City, the rest of the U.S., and across the world understood this sentiment too well due to the stress of relationships and a lack of self-esteem.
Callers, chatters, and texters to 1-888-NYC-WELL and nycwell.cityofnewyork.us can choose between a licensed crisis counselor and a certified peer specialist as well as the language to converse in.
Counselors assess risk in depth for suicide, homicide, and self-harm as well as for child and elder abuse, and domestic violence. They determine mental health status, provide brief counseling, and transfer clients to mobile crisis teams, EMS, police, or other authorities when safety planning is not possible.
Peers react to such crises using our lived experience and training to offer support more informally and, when additional clinical backup is needed, transfer callers to counselors.
Both counselors and peers respond to such major concerns as disruptions in life events, depression, anxiety, and other mental health challenges, substance use, functional, and social difficulties, and, especially during the Covid pandemic, the dangers of isolation.
We solve problems collaboratively, including coping skills derived from Cognitive Behavioral Therapy (positive thinking, thought stopping, motivational interviewing) and Dialectical Behavior Therapy (distress tolerance, emotional regulation, interpersonal effectiveness, mindfulness), as well as deep breathing, progressive muscle relaxation, and engaging in pleasant activities.
And we make referrals along the continuum of care for behavioral health and social services, summarize interactions for our callers and visitors (chatters and texters), and outline next steps, including natural supports and therapy.
Finally, we remind them of the 24/7/365 availability of NYC Well, offer a consumer survey, and write progress notes. If a crisis counselor determines their risk is high enough, other counselors follow up.
Working for NYC Well was more than a job for me. No longer able to care for my brother, who was quarantined in a nursing home, ironically freed me from that stress to come out of retirement and serve my fellow New Yorkers during their time of need.
This gave me a new lease on life, and, what we members of the Religious Society of Friends (Quakers), call “a leading.” Without proselytizing, I emphasis the mind-body-spirit connection and the other dimensions of wellness according to Drs. Peggy Swarbrick and Michelle Zechner.
Working from home during my noon to 8 PM shifts, I would occasionally be triggered by callers and visitors who reminded me of my brother with his diagnosis of serious mental illness. (May he rest in peace after his death on May 18, 2022.)
But, during the height of the pandemic, I, a survivor of multiple suicide attempts, would successfully support a couple of teenagers every day in the midst of their suicidal crises. Often estranged from family and friends, they found comfort talking to a survivor, who, at the age of 70, reminded them of the wise counsel they had received from grandparents, some of whom had died due to Covid.
These and the other peers I connected with viscerally in virtual time and space reinforced the belief that none of us can sustain ourselves without the milk of human kindness. Some were frequent callers/visitors who depended on us for their daily doses of warmth and reassurance.
And the beauty of the interactions with peers is that we learn from each other not only about our trials and tribulations but also our coping strategies. In particular, while not a hearer of voices, seer of visions, nor an empath myself, I listened without judgement to the different wavelengths on which some peers vibrate.
Our staff is as diverse as our callers and visitors according to race, class, sex, and gender. With the age distribution of peer specialists, counselors, and clients represented by a bell curve weighted toward youth rather than older age, I was everyone’s senior by 15 years. That my elder peers hardly called—they never chatted nor texted—is undoubtedly a reflection of not only our lack of media savvy but also the stigma of mental illness and substance abuse among us.
However, don’t take my word for what working on a hotline is like. (Wound up like the Energizer Bunny after a shift, I would often unplug by listening to syndicated talk radio host Delilah’s advice for the loved and lovelorn or Christian rock radio, K-LOVE.) Here are words of wisdom from NYC Well’s director, Gail Bower, peer specialist Mantasha Sharif (a member of my training class), and my peer supervisor, Daesia Jameslouis:
Carl Blumenthal: What’s the history of NYC Well?
Gail Bower: In 1995 Lifenet was launched by the Mental Health Association of NYC (now Vibrant Emotional Health). Lifenet provided support, information and referral, and crisis services via phone 24/7/365, and linked individuals to NYC’s behavioral health resources. Chat and text were added later to reach out to Lifenet counselors.
Following 9/11, Lifenet’s number served as the primary starting point for NYC residents seeking support through Project Liberty, a program administered by the NYS Office of Mental Health to provide crisis counseling for individuals experiencing psychological distress due to the events of September 11th.
In April 2016, Vibrant Emotional Health (Vibrant) was awarded NYC Well under Mayor Bill DiBlasio’s ThriveNYC initiative. NYC Well expanded the services already offered by Lifenet with the addition of peer support, warm transfers to resources, and follow-up. Thus, NYC Well connects New Yorkers and others day and night for free to confidential, high-quality behavioral health care.
The inclusion of peer support staff was a significant and positive complement to the services already offered by counselors. Over the last six years, the demand to speak with peer staff has grown and now accounts for approximately 20% of the approximately 500,000 calls, chats, and texts received annually.
In addition to NYC Well, Vibrant’s Here2Help Connect crisis contact center manages a variety of contracts, including after-hours lines for managed care companies, a bullying hotline, and a line for NFL players and family members, plus one for disaster response. It also serves as a 988 chat and text center.
In 2001, the U.S. Substance Abuse and Mental Health Service Administration (SAMHSA) awarded a grant to Vibrant Emotional Health to establish a network of local crisis centers and administer the National Suicide Prevention Lifeline (NSPL), which transitioned to the 988 Suicide & Crisis Lifeline (988 Lifeline) in July 2022.
Carl: How did the Covid pandemic affect operations:
Gail: Since 2006 the H2H contact center has had an established team of remote counselors and peer support specialists, recognizing the need to have staff available during a disaster or weather event.
When the pandemic required staff to work remotely, having the infrastructure in place meant IT did not have to start from scratch. However, the task of transitioning the majority of Vibrant’s employees, not just the contact center, was still tremendous. Vibrant’s IT team and H2H’s operations staff, with the support of management, worked tirelessly so the contact center staff could quickly transition to working from home. When thinking back to that time about everything staff did on short notice, it really is nothing short of amazing.
A completely 100% remote workforce has enabled us to expand our pool of candidates for employment outside the metro area. This helped not only with recruitment efforts in general but also, with people on the West coast being three hours behind, it became easier to fill shifts starting later in the day.
Carl: Mantasha Sharif and Daesia Jameslouis (DJ), why did you become peer support specialists and what was your experience before you joined NYC Well?
Mantasha: I’ve had anxiety most of my life, but I didn’t know what it was until I had therapy at age 21. I was a server in a restaurant before this job, so I had to learn how to manage my anxiety and not judge myself. I had no formal training as a peer specialist, although I provided peer-to-peer support with a young family member before that. Not everyone can speak up in a crisis, especially when there are cultural barriers and stigma about being called “crazy.” Having a mental illness is not wrong.
DJ: Before becoming a peer specialist, I worked as a crisis counselor, paralegal, and sexual assault advocate, and was in the United States Navy. I became a peer specialist to share my recovery story and knowledge in the field of mental health. I believe the biggest takeaway from my journey was gaining a complete understanding both psychologically and emotionally. When recovering, I felt sharing that experience with others could provide hope and also coping skills to better face their mental health challenges.
Carl: What were your expectations when you started and have they changed over time?
Mantasha: When I first started, I expected to talk to people in various stages of their personal journeys, and I certainly have. Connecting with a visitor over shared experiences, common interests, or coping skills is always great. I also expected to be in a supportive work environment, and the team has certainly lived up to those expectations. The peer supervisors, the peer team, and all other staff are always helpful, kind, and supportive.
DJ: As a future licensed clinical mental health counselor, I was helped by the Vibrant team with hands-on training to piece together psychological knowledge, a sense of competence when counseling clients, and the ability to support them through crises. Vibrant has continually allowed peers to provide psychoeducation and model recovery.
Carl: What was your training prior to NYC Well and what on the job?
Mantasha: The training at NYC Well before starting the job carried a lot of weight. And I’ve learned a lot on the job. But there’s always room for improvement. I was better on chats than on calls to start. And learning how to use our resource database took time. Now I’m learning a lot from the courses that the Academy of Peer Services requires for certification.
DJ: Training has provided much information regarding crisis counseling, intervention methods, supportive communication, and psychological knowledge. Before joining NYC Well, I obtained a degree in psychology and worked as a crisis counselor. When comparing both, Vibrant provided much more detailed hands-on training compared to other mental health positions.
Carl: What is the nature of your interactions with callers/visitors?
Mantasha: During the height of the pandemic, there was a lot of school stuff on the minds of chatters and texters. Over the semester, anxiety and depression went up with a lot of suicidal thoughts and self-harm. If you’re naturally empathetic and want to help people, then this is the place for you. We can support people because it’s awful to go through these things alone.
DJ: Peer specialists engage peers where they are, build trust through selective self-disclosure, actively listen without judging, validate their concerns, and affirm their strengths. Some callers simply want to vent, talk about a triggering moment, or cope through their ongoing mental health challenges. All want to be heard. Especially for callers who are new to their mental health diagnoses, peer specialists help them understand what it was like when we were first diagnosed and how we coped. We also assist individuals who are further along in their recovery and need a sense of hope by reinforcing the coping skills they have learned along the way.
Carl: How has your position or role changed since you began working there?
Mantasha: Being here for almost three years, I have learned how to better engage with struggling visitors and to not take things personally. Sometimes a listening ear and talking about how to get through the day go a long way. Calls and chats can be triggering, especially when they concern sexual assault and other trauma. But supervisors are always there to support us and there’s time to take breaks, including for self-care when needed. I didn’t practice self-care before because I’m an introvert who likes to be by myself. But now I don’t feel guilty taking the time for music, walking, writing, and reading.
DJ: When beginning with Vibrant, I was originally offered a crisis counselor position but soon changed to the peer specialist role. After working the job for six months, I moved to peer supervisor, which requires technical multi-tasking while supporting peer specialists on and off calls. Although the stress can be negative, knowing you have provided that listening ear and constructive feedback is an extremely rewarding benefit.
Carl: What are the greatest rewards and challenges of the job?
Mantasha: It feels very rewarding to make someone’s day or even just help them feel a little better than they were feeling before the interaction. Sometimes people need a space to be heard and be listened to. Most of the time, visitors have the tools within themselves to cope. It just takes a listening ear to remind them and help them reconnect to their own tools. One of the challenges of any helping profession is being prone to experiencing burnout.
DJ: Sharing your recovery story and psychological knowledge plays a big part in an individual’s recovery. Knowing you made that slight difference is extremely satisfying. The biggest challenge is disconnecting from clients. Support goes a long way when done collaboratively but can go even further when clients choose to utilize these skills on their own.
Carl Blumenthal is a peer counselor for the SAMHSA-funded Enhanced Treatment and Recovery (EnTRy) program of NYU Langone’s Sunset Terrace Family Health Center in Brooklyn, New York. He supports peers who have experienced psychosis. Carl has published more than 100 articles on behavioral health and a memoir, “Saved by Imagination: How Reading and Writing Restored My Mental Health.” For more information, email email@example.com or call (929) 283-2562.